[Intestinal obstruction caused by volvulus of Meckel's diverticulum. Description of a case]. / Occlusione intestinale da volvolo su diverticolo di Meckel. Descrizione di un caso.

A case of intestinal occlusion is reported caused by volvulus of Meckel's diverticulum. The etiological and clinical aspects are discussed together with their implications in terms of suitable surgical therapy.

[Technical note: double derivation of the omega loop in inoperable tumors of the pancreas head]. / Nota tecnica: doppia derivazione su ansa ad omega nei tumori inoperabili della testa del pancreas.

The paper illustrates a personal technique used in palliative surgery of extensive tumours of the head of the pancreas. An omega loop is prepared into which both the VBP and digestive tract are diverted, thus reducing the number of anastomoses to be performed and the length of the operation.

[The importance of intraoperative diagnosis in biliary lithiasis]. / L'importanza della diagnostica intraoperatoria nella litiasi biliare.

Intraoperative cholangiography continues to be the principal investigation in the intraoperative diagnosis of biliary disease. Cholangiography and preoperative echography, the clinical aspect are not sufficient to exclude the possibility of choledochal lithiasis in operations carried out for straightforward cholelithiasis. Personal experience in a series of 248 bile lithiasis operations is examined: intraoperative diagnosis was based on 244 cholangiographies, 41 echographies and 22 choledochoscopies. Choledochoscopy proved decisive for evidencing residual choledochal calculi after seemingly accurate choledocholithotomy operations and also after trans-Kehr intraoperative cholangiography. Intraoperative echography, in the light of rather limited experience, would seem to add nothing to the two previous associated intraoperative instrumental investigations; it may prove useful in certain special cases.

[Perforated diverticulitis of the colon. Problems of diagnosis and surgical tactics]. / Diverticolite perforata del colon. Problemi di diagnosi e di tattica chirurgica.

Perforated diverticulitis of the large bowel is a frequent observation in surgical practice. There is, however, no standard attitude to the procedures to be adopted: the only fixed point is the abandonment of straightforward colostomy and drainage. A series of 16 cases of perforated diverticulitis of the large bowel operated on in emergency and treated with various procedures, i.e. 8 Hartmann resections, 6 Paul-Mikulicz operations, 2 ideal colectomies, 2 colostomies and drainage. The observations made permit a number of considerations: 1) "ideal colectomy" is undoubtedly the best intervention providing the patient presents an early NPT and a temporary colostomy has been made to protect the anastomosis; 2) the rupture of a single diverticulum suggests the Paul-Mikulicz operation and it can be treated at a later stage by straightforward closure; 3) rupture of a diverticulum within the framework of extended diverticular involvement suggests Hartmann's resection; 4) colostomy and drainage should be abolished for its poor results and can be kept for patients in very serious condition.